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14 April, 2012

Sexually Abused child.

Abused child. (Photo credit: Wikipedia)

Perhaps one of the saddest symptoms, or to be more precise, signs* of a history of child abuse is cutting and self-mutilation.  Cutting is associated with more prolonged and serious sexual abuse.  Some research has shown that a combination of sexual abuse and straight physical abuse raises the probability of cutting. One survivor I worked with had a father who was a meth addict (as was her mother). She was traded for drugs and, of all horrors, given drugs and used by her father himself. The abuse went on for years and she became a regular cutter.

It can be difficult for people to understand why survivors cut but the universal explanation by survivors who do so is that enormous relief comes from doing so. It isn’t, in a direct sense, that the cutting is to punish one’s self.  It’s emotional relief that powers the habit. There is almost inevitably a sense of shame about the cutting, particularly having to explain the scars. Many survivors avoid detection of the cutting by cutting where people wouldn’t ordinarily see or notice the scars.  Upper legs, the bottoms of the feet and other normally-covered parts of the body become areas of choice for the cutting.

One survivor I was aware of would go further in the self mutilation.  She would put broken glass in the bottom of her bathtub and walk on the glass. In her case, it wasn’t just the mutilation itself but the pain as well that provided relief. I recall her facing surgery for a problem with one of her shoulders. Most people would face such a surgery with stoic dread. She was as excited about the prospect, and anticipated it with as much excitement as a child might with Christmas approaching.

The cutting, owing to the fast relief of emotional pain, rather quickly becomes quite literally an addiction. It is just as difficult an addiction to overcome as one to heroin or other physical addiction. The answer, of course, is to reduce or eliminate the source of the emotional pain from which relief is sought. Once again, this is one of those signs of ‘disorder’ that leads clinicians to employ such diagnoses as borderline personality disorder, but the practice is no less a part of the PTSD than hallucinations and phobias. Cutting alone is a powerful predictor of a history of childhood abuse.

A clinician in any healing profession, be it medicine, psychiatry or even chiropractic practice cannot heal anything except by accident unless the real problem is diagnosed and targeted in treatment. Whatever diagnosis might be stapled to the survivor, the clinician should not be thinking of treating their symptoms but, rather, treating the cause of them.


* A symptom is an internal experience which can only be revealed through questioning or self report, such as anxiety. A sign is something an observer can see, hear, touch, smell or detect through instruments, such as a fever.

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